• Patient care: ✓ Patient care areas/capacities: processes to maximize the use of regular patient care capacity (such as empty- ing the emergency department of admitted patients), and establishment of alternative areas of adequate care (such as transitioning critical patients to post-anesthesia care units, and clinical procedures areas that can sup- port critical care services). Accurate triage of arriving patients to appropriate areas of care is a vital process in accomplishing this objective. Engineered (managed) degradation of services should be incorporated into the patient care capacity planning. Delineating managed degradation strategies (see Chapter 9) that maintain the highest available level of care when capacity is exceed- ed is important: the use of hallways for patient care, the use of nontraditional personnel for patient care serv- ices (for example, paramedics to provide patient moni- toring in the hospitals), the use of medical students to provide prolonged bag ventilation are all options to prevent catastrophic failure of patient care services when planned capacity is exceeded. ✓ Patient tracking: adequate method of tracking patients through the system — internally within the healthcare facility and reporting externally to a medical care information node that conveys composite information to PSAT and forwarding to MH-LIF. ✓ Patient privacy: capability to retain patient privacy as much as possible. ✓ Lab and radiology ( see patient diagnostics). ✓ Ability to provide acute psychological interventions once diagnosed with mental illness — preferably sepa rate from clinical treatment areas if patient has been cleared of physical illness or injury. ✓ Morgue services: surge capacity should be integrated with the medical examiner’s emergency operations plan, the Mass Fatality Function, and law enforcement investigators. ✓ Discharge services: ability to rapidly identify inpatients who are stable for discharge, and expedite 7 - 12 7 MaHIM: Medical and Health Operations Functional Area
Joseph A. Barbera, M.D. Anthony G. Macintyre, M.D. Mass Casualty Medical and Health Incident Management The Institute for Crisis, Disaster, and Risk Management 7 MaHIM: Medical and Health Operations Functional Area discharge procedures while maintaining patient safety and understanding. This should be coordinated with the Post- acute Medical Care Sub-function. • Plant operations: ✓ Air intake: ability to close intake to buildings or selected areas of the buildings to provide shelter - in - place. ✓ Isolation of parts of building (e.g., smoke compartments). ✓ Structural evaluation: supported by Logistics, Structural Integrity Evaluation Processes. ✓ Waste disposal: capability to adequately dispose of increased waste load from the increased patient load.
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